Epilepsy is a very scary condition for both dogs and their owners. It is unpredictable, the seizures are very stressful, and without adequate treatment the disease can severely impact the lives of both the dogs and the people looking after them. Not only this, as dogs develop this condition early in life and unfortunately the condition can only be managed and not cured, management for epilepsy has to be a lifelong commitment.
It is understandable that this can seem like a daunting prospect as the owner of an epileptic dog, but it is important to remember that with medical support, monitoring and lots of love, your dog has the chance to live a happy and fulfilled life.
If you see your dog seizing for the first time it is important not to panic. Move any hard objects away from them and give them space to have their fit. Do not try and put your hand in their mouths – it is very unlikely that the tongue will obstruct the airway in a dog, and unfortunately as your dog cannot control their movements, you are liable to get bitten! If you can, try and time the length of the fit, and record the fit on your mobile phone, as this can help your vet in deciding what kind of fit your dog has had.
Your dog will likely be very disorientated and confused after a seizure. This is normal as the brain takes a while to start thinking normally again. This time is known as the ‘post-ictal’ phase. During this post-ictal phase try and behave calmly and reassuringly to your dog – they will pick up on your panic if you are stressed and we want them to be as relaxed as possible.
If your dog has had a seizure always made an appointment to see your vet. This does not have to be an emergency appointment unless your dog will not stop fitting, in which case an out of hours appointment is a must. When you see the vet they will take a full clinical history, examine your dog fully and may take some blood tests to see if there are any abnormalities. In animals who have epilepsy these blood tests usually do not show any worrying changes.
Once your vet has diagnosed epilepsy in your dog, a process that involves ruling out any other causes, a discussion will be had on the next step. Often if a dog has only had a single seizure, monitoring is started and treatment only put in place if they have further fits. This is to reduce medication and intervention in dogs that may only have a handful of seizures in a lifetime.
If, however, your dog has had more than one fit, or your veterinarian recommends to start treatment, anti-epileptic medications will be started.
In order to think about the action of anti-epileptic medications, we need to look closer at epilepsy itself. A seizure is simply a sudden surge of electrical activity in the brain. In dogs with epilepsy the ‘seizure threshold’, defined as the level of brain stimulation at which the brain will start to have a seizure, is lower than in animals without epilepsy. This means that in order to prevent seizures from happening we have to alter this seizure threshold to make it less sensitive.
Epilease is a prescription medicine and contains potassium bromide (KBr). KBr is a salt and it works by replacing chloride throughout the body. This doesn’t cause the body any damage, but the small change very slightly alters the charge of the nerve cells in the brain. This difference in charge means the nerves are ‘hyperpolarised’, and therefore need more stimulation before they fire, effectively raising the seizure threshold.
Epilease is often used alongside the pharmaceutical anti-epilepsy drug phenobarbitone. This works by increasing the activity of a neurotransmitter called GABA, which acts to quieten down the nerves. Phenobarbitone is a very effective drug, but like many drugs can have long term side effects. Using Epilease alongside phenobarbitone can reduce the doses of medication needed to control your dogs seizures, therefore reducing the chances of side effects such as liver failure developing.
At the recommended dose there should be no side effects of taking Epilease, although sometimes giving the dose all at once can make your dog feel a little sick – imagine eating a teaspoon of salt! If this is the case, divide the dose over the day and open the capsules, hiding the Epilease in food.
Although the risk of side effects at the recommended dose is very low it is important to monitor the levels in the blood. Epilease can take up to a month before it reaches a steady level in the blood, so the first blood test should be a month after your dog starts taking the capsules. This will allow your vet to see if the right dose of Epilease is being given. All dogs are aiming for the same concentration of Epilease in the blood, but different dogs need different amounts of Epilease capsules to reach this. This is because of their different sizes, but also because the amount of salt in the diet will impact on how effective the KBr salt is – remember they compete! It is important that when you have reached a therapeutic level of Epilease for your dog, you do not alter their diet, as this can have a knock on effect on the Epilease levels.
If you have too much KBr in the blood this can cause side effects, such as being very wobbly and sedated. If this occurs, depending on the severity of symptoms, your vet will either decrease the Epilease dose, stop the Epilease for a few days and restart on a lower dose, or put your dog on a drip to flush out the Epilease.
Once your dog is stable on their medication and diet, regular check-ups by your vet are important to ensure the long term health of your dog and make sure that your dog does not require any extra medication. Blood tests every six months should be done to check the levels of Epilease are still within the therapeutic level, and more frequent visits should be made if there are any changes to your dogs normal epileptic patterns.
With time, regular checks and appropriate treatments epilepsy does not have to be a scary disease for you or for your dog.
If your dog has seizures ask your vet for more information on Epilease – It might help change their life.
Dr Lauren Morfee BVSc MRCVS